Surgical system with hermetically sealed endoscope

ABSTRACT

In one embodiment, a minimally invasive surgical system includes a patient side manipulator, a hermetically sealed endoscopic camera instrument, a vision cart, and a monitor. The patient side manipulator has a robotic arm. The endoscopic camera instrument has a housing at a proximal end to couple to the robotic arm. The endoscopic camera instrument further has a hermetically sealed camera sensor at a distal end, a shaft coupled to the housing, and a wristed joint coupled between the shaft and the camera sensor. The vision cart has a camera control unit coupled in communication with the hermetically sealed camera sensor to capture the images of the surgical site. The monitor is coupled in communication with the camera control unit to display the captured images of the surgical site.

CROSS REFERENCE TO RELATED APPLICATIONS

This United States (U.S.) patent application claims the benefit and is acontinuation of U.S. patent application Ser. No. 15/394,703 filed onDec. 29, 2016 by David D. Scott et al., entitled ENDOSCOPE WITH DISTALHERMETICALLY SEALED SENSOR, now allowed. U.S. patent application Ser.No. 15/394,703 claims the benefit and is a continuation of U.S. patentapplication Ser. No. 15/018,867 filed on Feb. 09, 2016 by David D. Scottet al., entitled, HERMETICALLY SEALED ENDOSCOPE WITH OPTICAL COMPONENTATTACHED TO INNER PROTECTIVE WINDOW, issued as U.S. Pat. No. 9,565,997.U.S. patent application Ser. No. 15/018,867 claims the benefit and is acontinuation of U.S. patent application Ser. No. 14/662,083 filed onMar. 18, 2015 by David D. Scott et al., entitled, STEREO CAMERA FORHERMETICALLY SEALED ENDOSCOPE, issued as U.S. Pat. No. 9,271,633. U.S.patent application Ser. No. 14/662,083 claims the benefit and is acontinuation of U.S. patent application Ser. No. 14/030,122 filed onSep. 18, 2013 by David D. Scott et al., entitled, HERMETICALLY SEALEDENDOSCOPE, issued as U.S. Pat. No. 9,005,113. U.S. patent applicationSer. No. 14/030,122 claims the benefit and is a continuation of U.S.patent application Ser. No. 12/780,898 filed on May 15, 2010 by David D.Scott et al., entitled HERMETICALLY SEALED DISTAL SENSOR ENDOSCOPE,issued as U.S. Pat. No. 8,556,807. U.S. patent application Ser. No.12/780,898 is a non-provisional application that claims the benefit andis a continuation-in-part of U.S. patent application Ser. No. 11/614,661filed on Dec. 21, 2006 by inventors David C. Shafer, et al., entitledSTEREOSCOPIC ENDOSCOPE, issued as U.S. Pat. No. 8,814,779, which isincorporated herein by reference.

FIELD

Aspects of the embodiments generally relate to minimally invasivesurgical systems.

BACKGROUND

Minimally invasive medical techniques are aimed at reducing the amountof extraneous tissue that is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. The average length of a hospital stay for astandard surgery may also be shortened significantly using minimallyinvasive surgical techniques. Thus, an increased adoption of minimallyinvasive techniques could save millions of hospital days, and millionsof dollars annually in hospital residency costs alone. Patient recoverytimes, patient discomfort, surgical side effects, and time away fromwork may also be reduced with minimally invasive surgery.

The most common form of minimally invasive surgery may be endoscopy. Theendoscopic surgical instruments generally include an endoscope (forviewing the surgical field) and working tools. In endoscopic surgery,the working tools are similar to those used in conventional (open)surgery, except that the working end or end effector of each tool isseparated from its handle by an extension tube. As used herein, the termend effector means the actual working part of the surgical instrumentand can include clamps, graspers, scissors, staplers, and needleholders, for example.

To perform endoscopic surgical procedures, the surgeon passes theseworking tools or instruments through the cannula sleeves to an internalsurgical site and manipulates them from outside the abdomen. The surgeonmay monitor the procedure within the internal surgical site by means ofan endoscope, also referred to herein an endoscopic camera. Minimallyinvasive surgeries where an endoscopic camera is used are well known(e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy,cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy and thelike).

After each surgery, federal and state health regulations require thatsurgical tools be treated to prevent infection. Surgical tools that areto be reused are often cleaned, disinfected, and then sterilized afteruse in a prior surgery. Surgical tools may be cleaned with water, anenzymatic cleanser, and a scrub brush. Common methods of disinfectingsurgical tools involves bathing them in a chemical disinfectant so thatthe surgical tool can be passed around within a hospital with a lowlevel risk of infection. However, after being disinfected, a surgicaltool shouldn't be used for surgery as not all bacterial has been killed.A surgical tool that is to be reused in another surgery should undergo afurther sterilization process where all bacterial are killed so that thetool can be used again for surgery without transmitting bacteria fromone patient to another. The sterilization process involves either achemical sterilization using chemical sterilization techniques or asteam sterilization process using an autoclave.

Disinfection and sterilization by immersion in a chemical liquid may notbe as environmentally friendly. Disposal of the used chemical is costlyand may cause harm to the environment. Another drawback is that thechemicals are generally corrosive. Furthermore, chemical disinfectionand sterilization may be slower than other methods. Thus, a surgicalinstrument may have greater lag time between surgeries.

Similarly, disinfection and sterilization using chemical gases such asethylene oxide also have their drawbacks. Such gases are highly toxicand/or flammable. Extreme care must be used during and after thedisinfection and sterilization process to ensure the safety of both thepatient and medical staff. Disinfection and sterilization using gasesmay be complicated. A surgical instrument may have greater lag timebetween surgeries.

Almost all medical facilities have an autoclave and prefer to use steamsterilization of surgical instruments when they can. Commonly known asautoclave sterilization, this method of sterilization rapidly andeffectively sterilizes surgical instruments without toxic chemicals andlengthy procedures. Autoclaving standards vary but two common standardsrequire 134 degrees centigrade (C) at 2 atmospheres for 3 minutes (U.S.Standard) and 134 degrees Celsius at 2 Atmospheres for 18 minutes(European Standard). Autoclaving requires less time than otherdisinfection methods and does not require the use of toxic chemicals.However, some surgical instruments can't tolerate the heat and moisturefrom steam sterilization in an autoclave.

The steam from autoclaving may cause conventional endoscopes to fail.Pressurized steam may damage the adhesives, optics, electronics,focusing mechanisms, and opto-electronics (e.g., image capturingcircuit). Moisture in the endoscope may also condense on a lens and blurimages. The adhesive mount for the lens of an endoscope may be adverselyaffected by the heat and moisture of an autoclave. A stereoscopic lenssystem is especially susceptible to autoclave damage, because therelative alignment of the right and left lenses (optical paths) isimportant to rendering depth in the stereo image. Heat deformation of alens mount due to thermal expansion effects may alter the relativealignment of the stereoscopic lenses.

BRIEF SUMMARY

Certain aspects of the embodiments are summarized by the claims.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1A is a system diagram showing the various components of anendoscopic camera system for use in robotic surgery.

FIG. 1B is a system diagram illustrating various components of aminimally invasive surgical system with the endoscopic camera system ofFIG. 1A.

FIG. 2A is an exploded perspective view of portions of an embodiment ofa cylindrical shaped camera module.

FIG. 2B is a perspective view of an embodiment of a cylindrical shapedcamera module with a polygonal inner housing.

FIG. 2C is a top view of a cylindrical shaped camera module withpolygonal inner housing.

FIG. 2D is a top perspective view of a substrate.

FIG. 2E is a back perspective view of a substrate with attached ribbonconnector.

FIG. 2F is a perspective view of an embodiment of a cylindrical shapedcamera module with polygonal inner housing with cap assembly removed.

FIG. 2G is a perspective view of an embodiment of a cylindrical shapedcamera module with polygonal inner housing with cap assembly attached.

FIG. 2H is a perspective view of a subassembly of the inner housing ofthe cylindrical shaped camera module with upper and lower polygonalinner portions and cap assembly removed.

FIG. 2I is a bottom view of a subassembly of the inner housing of thecylindrical shaped camera module.

FIG. 2J is a side perspective view of an assembled cylindrical shapedcamera module.

FIG. 2K is a side view of the assembled cylindrical shaped camera moduleshown in FIG. 2J.

FIG. 2L is a top view of the assembled cylindrical shaped camera moduleshown in FIGS. 2J-2K.

FIG. 3A is a side diagrammatic view of a coaxial double walledcylindrical shaped camera module.

FIG. 3B is a side diagrammatic view of another coaxial double walledcylindrical shaped camera module.

FIG. 4A is a perspective view of a rectangular shaped camera module.

FIG. 4B is perspective view of a rectangular shaped camera module withboth housings removed.

FIG. 5A is a magnified side schematic view of the camera moduleillustrated in FIGS. 3A-3B.

FIG. 5B is a magnified side schematic view of an alternate embodiment ofa camera module.

FIG. 6A is a block diagram of a stereoscopic image sensor.

FIG. 6B is a block diagram of a controller/processor/converter for thestereoscopic image sensor of FIG. 6B.

FIG. 7 is a diagrammatic diagram illustrating the left and right pixelarray offset from the optical axis for stereo image convergence.

Like reference numbers and designations in the drawings indicate likeelements providing similar functionality. The figures are not drawn toscale so that elements, features, and surface structure may be shown byexample and are intended merely to be illustrative and non-limiting ofthe aspects of the embodiments that are claimed.

DETAILED DESCRIPTION

This detailed description describes exemplary implementations that areillustrative of aspects of the embodiments, and so it is explanatory andnot limiting. The claims define inventive aspects. In the drawings, someelements have been omitted to more clearly show inventive aspects.

Introduction

A robotic surgical system allows the surgeon to see and operate inside apatient's body without opening up the entire body cavity. Roboticsurgical arms perform the surgery through small entry ports in thepatient's body. These surgical arms are controlled by a surgeon at asurgeon's console control station. A video image of the surgical sitemay be captured by an imaging device attached to a robotic appendage andinserted into the surgical site. Video monitors at the surgeon's consoledisplay the video image of the surgical site. Using a real time displaythe surgeon coordinates the movement of the robotic arms and manipulatesthe attached surgical tool or end effectors.

Surgical tools, including imaging device, surgical scissors, graspers,or laser cutters, etc, are connected to a wristed joint capable ofmultiple degrees of freedom of movement. The wristed joint may use disksor vertebrae and actuation cables or tendons to allow a surgeon toremotely manipulate the end effector within small tight enclosures witha high degree of precision from a master control workstation or console.An exemplary wristed joint is described in detail in U.S. Pat. No.6,817,974 entitled SURGICAL TOOL HAVING POSITIVELY POSITIONABLETENDON-ACTUATED MULTI-DISK WRIST JOINT filed by Thomas G. Cooper et al.on Jun. 28, 2002 which is incorporated herein by reference.

An image device described as one embodiment is a video camera to capturevideo images of the surgical site. A video camera may capture images inthe visible and near infrared (NIR) spectrum and uses one or more lightsources in the visible and near infrared to illuminate the tissuesurface in a surgical site. A digital video camera with a charge-coupleddevice (CCD) or complementary metal oxide semiconductor (CMOS) sensormay be used to capture digital video images of a surgical site. A bundleof optical fibers, connected at one end to a light source, may be usedas light pipes to direct light down into the surgical site and providethe illumination to capture the digital video images. The video imagescaptured by the camera may be transmitted to one or more viewingmonitors that a surgeon uses to visualize the internal anatomy and guideany surgical procedures. The video images can be captured and displayedmonoscopically by using a non-stereo camera and a single display device,or captured and displayed stereoscopically by using a stereo camera anda stereo display device.

Further information regarding robotic surgical systems may be found, forexample, in U.S. patent application Ser. No. 11/762,165, entitledMINIMALLY INVASIVE SURGICAL SYSTEM, filed by David Q. Larkin et al. onJun. 13, 2007 (U.S. Pat. No. 9,060,678); and U.S. Pat. No. 6,331,181,entitled SURGICAL ROBOTIC TOOLS, DATA ARCHITECTURE, AND USE, filed byTierney et al on Oct. 15, 1999, both of which are incorporated herein byreference.

Distal Sensor Endoscope System Overview

To perform the precise movements necessary in endoscopic andlaparoscopic surgery, it is imperative that the surgeon has a clearunobstructed view of a surgical site.

FIG. 1A is a block diagram illustrating a schematic representation of anendoscope camera system 100. The endoscope camera system 100 is a partof a robotic surgical system for viewing the surgical site within apatient. The endoscope camera system 100 includes an endoscopic camerainstrument 101, a camera control unit (CCU) 112, and an illuminator 116coupled together as shown.

The endoscopic camera instrument 101 comprises a camera module 102, ahollow instrument shaft 106, an instrument housing 107, and cables110,114 coupled together as shown. The instrument housing 107 includesan interface base configured to mount to and dismount from a roboticarm. The instrument housing may have an electrical connector (not shown)to couple to an electrical connector of the robotic arm to communicatecontrol signals. The camera model 102 may be coupled to the distal endof a joint of one or more joints 104 of the instrument so that it iscapable of one or more degrees of freedom of movement. One or more ofthe joints 104 may be a wristed joint coupled to an end or considered tobe a part of the instrument shaft 106. One or more of the joints 104 maybe joggle joints with a joggle links there between. The instrument shaft106 is relatively long and thin so as to pass through a cannula sleevein an entry port of a patient into an internal surgical site.Alternatively, the instrument shaft 106, joints 104, and camera module104 of the instrument 101 are inserted into an entry guide that ispassed through the cannula sleeve into the body. A proximal end of theinstrument shaft 106 is coupled to the instrument housing 107. Theinstrument housing 107 houses the mechanisms (not shown) to manipulatecables to move the joints 104 and the camera module 102 within asurgical site under control of the operating surgeon.

The camera instrument 101 is coupled to a robotic arm of a Patient SideManipulator (PSM) 103 under the control of the operating surgeon thatmay move the shaft 106, the joints 104 and the camera module 102 withinthe surgical site. The wristed joints 104 allow articulation inside thepatient body cavity with minimal movement of the instrument shaft 106.For example, the wristed joint 104 may allow a surgeon to move thecamera module to view an organ from multiple angles, while theinstrument shaft 106 remains stationary. The wristed joints 104 arearticulated by a plurality of cables nested within the wrist joint andextending back through the instrument shaft 106 into the instrumenthousing 107. Ends of the cables may be taken in or let out to articulatemovement in a joint.

In one embodiment, the joint 104 nearer the midpoint of the shaft is aparallel motion mechanism, also referred to herein as a joggle joint. Aparallel motion mechanism allows the position of a reference frame atthe distal end of the mechanism to be changed with respect to areference frame at the proximal end of the mechanism without changingthe orientation of the distal reference frame. A parallel motionmechanism (joggle joint) and a wristed joint (wrist mechanism) that maycouple to an end effector, such as the camera instrument module 102, arefurther disclosed in U.S. patent application Ser. No. 11/762,165,entitled MINIMALLY INVASIVE SURGICAL SYSTEM, filed by Larkin et al. onJun. 13, 2007 (U.S. Pat. No. 9,060,678) which is incorporated herein byreference.

Sheathed electrical cables 110 may detachably couple at one end to thecamera control unit (CCU) 112 and run through the instrument housing107, instrument shaft 106, and the wristed joint 104 to couple to thecamera module 102. In one embodiment, the sheathed electrical cables 110include electrical cables to allow the transmission of video signalsfrom the camera module 102 to the CCU 112. In one embodiment, thesheathed electrical cables 110 also include an optical fiber to allowthe transmission of video signals from the camera module 102 to the CCU112. Control signals and power/ground may also be routed over electricalcables in the sheathed electrical cable 110 between the CCU 112 and thecamera module 102. The control signals may be used to control the cameramodule 102, the capture of images in the surgical site, and thetransmission of images to the CCU 112.

In FIG. 1A, video images in a video signal processed by CCU 112 from thecamera module 102 may be displayed in stereo on a stereo viewer 118B ordisplayed on a monitor 118A mounted to a vision cart 105. In someembodiments, the CCU 112 and the illuminator 116 are also componentsmounted onto the vision cart 105. In other embodiments, the CCU 112 maybe incorporated into a master control console where the surgeon maycontrol the endoscopic camera system 100 or into the patient sidemanipulator 103.

A light guide 114 formed of one large optical fiber or a bundle ofstrands of optical fiber has a light guide connector 124 to couple tothe illuminator 116 to receive light. The external illuminator 116 mayinclude one or more of a Xenon short-arc lamps, a lasers, light emittingdiodes (LEDs), and/or other types of light generators. The light guidedirects the generated light out its distal end(s) out from the cameramodule 102 near an image sensor. With a plurality of strands of opticalfiber, the light guide 114 can terminate at more than one point at thedistal end of the camera module 102 and provide multiple light points.As further detailed below, individual threads or strands of opticalfibers may be placed in a mold and bonded with epoxy to create shapedlight emitters. The fiber optic cables may be bundled together andsheathed so that they may be routed through the center of the instrumentshaft 106 and the one or more joints 104 to the camera module 102.

Alternatively to illuminate a surgical site with light, one or more LEDsmay be included as part of the camera module 102, space permitting,instead of employing the light guide 114 and its fiber optic cablescoupled to the external illuminator 116.

Sterilization and safety regulations require that surgical toolsincluding endoscopic camera instruments 101 are sterilized prior to eachsurgery. The modular instrument housing 107 and quick disconnect cables110,114 allow the endoscope system 100 to be quickly detached and usedin another surgery. The light guide cable 114 and/or the sheathedelectrical cables 110 may further include intermediate connectors109,108 respectively to further facilitate a quick disconnect forsterilization. An autoclave can sterilize an instrument in minutes, butthe surgical instrument must be capable of withstanding the intenseheat, moisture, and pressure of an autoclave. The delicate sensors of anendoscope are especially susceptible to the steam cleaning process of anautoclave. By hermetically sealing the delicate optical components of anendoscope, without organic adhesives, an autoclaveable surgical tool maybe achieved.

Referring now to FIG. 1B, the minimally invasive surgical system 190generally includes the master control console or workstation 150, thepatient side manipulator 103, and the vision cart 105 coupled incommunication together. The master control console 150 generallyincludes master controllers (not shown) which are grasped by the surgeonand manipulated in space while the surgeon views the procedure on thestereo display 118B. The master controllers are manual input deviceswhich preferably move with six degrees of freedom, and which oftenfurther have an actuatable handle for actuating tools (for example, forclosing grasping jaws, applying an electrical potential to an electrode,or the like). The master control console 150 includes at least oneprocessor 152 to control the system 190.

The patient side manipulator 103 is positioned adjacent to the body of apatient P and moves tools, such as the camera instrument 101, that haveshafts. The shafts extend into an internal surgical site within thepatient body via openings O. As illustrated in FIG. 1B, one or moreassistant may be present during surgery to assist the surgeon,particularly during removal and replacement of tools. The patient sidemanipulator 103 includes a base from which surgical tools, including thecamera instrument 101, are supported. More specifically, the surgicaltools are each supported by a series of manually articulatable linkages,generally referred to as set-up joints, and a robotic arm ormanipulator.

Cylindrical Endoscopic Camera Module

One embodiment of a hermetically sealed distal sensor endoscope may beachieved by forming the camera module 102 within a moisture resistantcylindrical structure so the camera module is autoclaveable. A firsthollow moisture resistant housing (inner housing) encloses opticalcomponents such as lenses and image sensors. Optical fibers of the lightguide are arranged around the first housing. A second hollow housing(outer housing) encloses the optical fibers, the first housing, and theoptical components.

Referring now to FIG. 2A, a perspective view of a double walledcylindrical structure 200A with a moisture resistant inner housing isshown that may be used to house the electrical, optical, andelectro-optical components of the camera module 102. The double walledcylindrical structure 200A includes an outer hollow cylindrical housing(may also be referred to as an outer can or outer housing) 202 and aninner hollow cylindrical housing (may also be referred to as an innercan or inner housing) 204A that is coaxial with the outer hollowcylindrical housing 202 along an axis 229. The double walled cylindricalstructure 200A further includes a window 206A hermetically sealed to thedistal end of the inner housing 204A with a hermetic sealant forming afirst hermetic seal 314A. A substrate 208A hermetically sealed to theproximal end of the inner housing 204A with a second hermetic sealantforms a second hermetic seal 318A. The ceramic substrate 208A, showndetached from the inner housing 204A in FIG. 2A, acts as a hermeticbarrier.

The inner housing 204A and the outer housing 202 may be made ofstainless steel, titanium, another metal or metal alloy (e.g., KOVAR, anickel-cobalt ferrous alloy) sufficiently strong and light enough to beused in surgical instruments. The material chosen to form the innerhousing 204A and the outer housing 202 should be able to withstand theheat and moisture of an autoclave as well as the oxidizing conditionsfound in most surgical sites. Another consideration when selecting thematerial to form the inner housing 204A is thermal expansion. The innerhousing 204A is welded to ceramic substrate 208A. If the materials eachexpand at a different rate while welded together, stress fractures maydevelop in the ceramic or the welds. In order to reduce stress on theceramic substrate due to thermal expansion, it may be beneficial to formthe inner housing out of a material, such as a nickel-cobalt ferrousalloy (KOVAR), which substantially matches the thermal expansioncoefficient of the substrate (the substrate is a high temperatureco-fired multilayer ceramic in one embodiment) and a window (e.g., asapphire window) so that hermetic seals between each survive asterilization process in an autoclave. In an alternate embodiment, theouter housing 202 is over-molded silicon formed by over molding siliconaround the inner housing 204A, optical fibers 312, and the segment 240into the shape of the outer housing 202.

Both the outer cylindrical housing 202 and the inner cylindrical housingmay have a similar hollow shape but with different diameters and/orradiuses. In one embodiment, both the outer cylindrical housing 202 andthe inner cylindrical housing 204A have a hollow oval or ellipticalcross-section. Note that the term cylinder is used herein in a broadsense to not only encompass circular cylinders with a circular or ovalcross section but all types of polygonal shaped cylinders with a polygoncross section that may alternatively be referred to as a prism.

Sandwiched in between the outer housing 202 and inner housing 204A are aplurality of optical fibers (not shown in FIG. 2A; see optical fibers312 shown in FIG. 2B, for example). The optical fibers may be bundledinto cables and routed to specific points at the top of the endoscopiccamera 202 to provide light from discrete light points. For example,four bundles of optical fibers may be routed to the cardinal points atthe distal end of the camera module 200B to produce light from fourpoints around the camera lens such as shown in FIG. 2C. Alternatively,the optical fibers may be placed continuously between outer housing 202and inner housing 204A to provide a “halo” light source around thecamera window. In both embodiments, the optical fibers are polished atthe distal end flush with the outer housing 202 edge to provide a smoothtop surface, which prevents the intrusion of biological matter and iseasier to clean. If the optical fibers are routed to specific points,then a sealant or potting material (e.g., silicon epoxy) may be placedbetween the outer housing 202 and inner housing 204A to provide abarrier. As previously mentioned, the optical fibers may be gatherednear the base of the camera module 102 and routed down the central axisof the wristed joint and instrument shaft to connect to an externalilluminator 116. A sheath may be used to protect the optical fiberbundles as they extend down the length of the endoscopic camerainstrument 101.

Optical components for focusing incoming light and capturing images arehermetically sealed within the inner housing 204A to avoid moistureduring steam sterilization in an autoclave. The inner housing 204A mayalso be grounded to form a Faraday cage and shield internal componentsfrom electrical noise. To hermetically seal the inner housing 204A, aceramic substrate (a base) 208A and a window (a lid) 206A are attachedto open ends of the inner housing 204A. A first hermetic seal 314A iscreated by soldering the perimeter of the window (lid) 206A to theinside edge of the distal end of the inner housing 204A. A secondhermetic seal 318A is created by welding the perimeter of the ceramicsubstrate (base) 208A to the inside edge of the proximal end of theinner housing 204A.

In FIG. 2A, a portion of camera module 200A is detached from the bottomof inner housing 204A. The ceramic substrate (base) 208A is shownhermetically sealed to a ring 228. The ring 228 in turn is coupled tothe inner housing 204A. The substrate (base) 208A may be made of ahigh-temperature co-fired multilayer ceramic substrate. The ring 228 maybe a metal ring (e.g., a nickel-cobalt ferrous alloy such as KOVAR) thatis welded to a metal inner housing. A first set of bond pads 210B (seepads 210B in FIG. 3A) are on the outer surface of ceramic substrate 208Aand are electrically connected to a second set of bond pads 210A on theinside surface of ceramic substrate 208. Metallization of the outsideedge of ceramic substrate 208A may improve welding of the ceramicsubstrate 208A to the ring 228. Alternatively, a ring of gold may bedeposited on top of ceramic substrate 208A near the perimeter. Innerhousing 204A may be placed atop the deposited gold and welded, brazed,or laser welded to the ceramic substrate 208A.

Polygonal Inner Housing

FIG. 2B is a perspective view of a camera module 200B with an innerhousing 204B having a different shape than that of the inner housing204A. While the inner housing 204B is still a hollow cylinder andcoaxial with the outer housing 202, it has a polygonal-shaped crosssection to provide greater interior volume that accommodates relativelylarger optical and electrical components than a similarly sized cylinderwith a curved cross section. In one embodiment, the inner housing has anoctagon-shaped cross section. The cross section of the substrate and thering (shown in FIG. 2D and 2E) also matches the polygonal shape of theinner housing 204B as does the cross section of the window 206B shown inFIG. 2B. As better shown in FIG. 2G, the hollow polygonal shaped innerhousing 204B includes an upper hollow polygonal shaped inner housingportion 205U and a lower hollow polygonal shaped inner housing portion205L. An opening of the lower hollow polygonal shaped inner housingportion 205L is closed by the ceramic substrate (base) 208D. An openingof the upper hollow polygonal shaped inner housing portion 205H isclosed by the polygonal shaped window 206B.

A top view of the camera module 200B, shown in FIG. 2C, illustrates thepolygonal shaped window 206B coupled to the upper hollow polygonalshaped inner housing portion 205U of the inner housing 204B by ahermetic seal 314B conforming to the polygonal shape. A plurality ofoptical fibers 312 are positioned at points between the inner housing204B and the outer housing 202. A dielectric epoxy 250B fills the gapsbetween the inner housing 204B, the optical fibers 312, and the outerhousing 202.

FIG. 2D is a perspective view of the inner side of the polygonalsubstrate 208D. The inner side of the polygonal substrate 208D includesa cutout recess 220 to receive an image sensor and a processor (e.g.,image sensor 320B and signal conditioning processor 326B shown in FIGS.5B, 6A-6B). Above and below recess 220 are bond pads 210A and 210B formaking electrical connections to the image sensor 320B and processor326B. As mentioned previously, a layer of gold is deposited around theperimeter of the substrate to facilitate a metal to ceramic bond. A goldlayer 226 deposited around the perimeter of the polygonal substrate 208Dallows the lower portion 205U of the inner housing 204B to be welded orsoldered onto the polygonal substrate 208D.

FIG. 2E shows a perspective view of an outer side or backside of thepolygonal substrate 208D. On the backside of polygonal substrate 208Dare multiple bond pads 210E. Bond pads 210E allow a ribbon connector 230to be surface mounted to the bond pads on the back side of polygonalsubstrate 208D. The use of the ribbon connector 230 capable of receivinga ribbon cable can be advantageous for quick removal and replacement ofthe camera module 102. Although there are some advantages to usingribbon connector 230, other types of connectors may be substituted withsimilar results. Other means of transmitting data to and from a distalmounted endoscope are detailed below in the description of FIGS. 3A-5B.

FIGS. 2F-2G are perspective views illustrating assembly of the polygonalinner housing 204B. In FIG. 2F, a pair of lens barrels 235, alsoreferred to as lens tubes, are placed within the lower portion ofpolygonal inner housing 204B separately aligned with respective pixelarrays of an image sensor as further described herein. Alternatively,the lenses and other optic devices may be held in a common lens holdingstructure that provides for alignment with the pixel arrays of the imagesensor.

The lower and/or upper portions of the inner housing 204B provide aframe to hold the lens barrels. The pair of lens barrels 235 may beglued or laser welded to the lower and/or upper portions of the innerhousing 204B. The pair of lens barrels 235 and the lower and/or upperportions of the inner housing 204B are designed to be thermally matchedso that the lenses and other optic devices do not suffer misalignmentduring and after an autoclave sterilization process. Rails 260 may bemounted on the inside of polygonal inner housing 204B to help hold thelens barrels 235 aligned in place.

Lens barrels 235 may comprise a metallic tube to allow spot welding torails 260. The lens barrel 235 may be formed out of a material with asimilar coefficient of thermal expansion as the inner housing 204B tohelp reduce stress fractures. Lens barrels 235 hold the optics (e.g.,one or more lenses) for focusing incident light onto the image sensor. Aplurality of lenses are placed within the lens barrel 235 and separatedby spacers. It is advantageous to form the lens barrel 235 without usingadhesives due to the intense heat a camera module 200B will encounter inan autoclave. Melted glue may impair the focusing abilities of lensbarrel 235 and blur the resulting image. However, heat-resistant gluesmay be used to glue optical components such as the lens barrel 235 to atransparent window.

In an alternative embodiment, inner housing 204B may be a solidcylindrical shape with tunnels bored out of the solid cylindrical shapeto hold the lens barrels 235. In such an embodiment, the rails 260 mayno longer be needed to hold the lens barrels in place.

Substrate 208D may be hermetically sealed to the bottom half 205U ofinner housing 204B by soldering or welding to form a lower subassembly216 of the inner housing. A ribbon connector 230 may be surface mountedto bond pads on the back side of substrate 208D for data transmission.The ribbon cable 238 has electrical wires that may couple to terminalsof the ribbon connector 230.

For each camera module 200A-200B, the window (lid) 206A,206B is coupledto the distal end of the inner housing 204A,204B. The window 206A,206Bmay be made of any suitably scratch-, heat-, moisture-, andsolvent-resistant material that is also transparent to a range ofwavelengths of light detected by the image sensor behind the window. Inone embodiment the window (lid) 206A,206B is a sapphire window brazedonto the inner wall or an edge of the upper housing portion 205U of theinner housing 204A,204B. To braze a sapphire window 206A,206B onto ametallic surface, the peripheral edge of the sapphire window may bemetalized to aid adhesion. In other embodiments, the sapphire window206A,206B may be gold soldered to the upper housing portion 205U of theinner housing 204A,204B using a gold solder to form the hermetic seal.In another embodiment, glass frit technology may be used to bond andseal the sapphire window to the inner housing. In this case, a glassfrit sealant is used to form a glass frit seal about the sapphirewindow.

Once the lens barrels 235 are placed within inner housing 204A,204B andproperly aligned with the image sensors, the inner housing 204A,204B ishermetically sealed. In one embodiment, an open end of a cap assembly215 is placed over the lens barrels 235 and laser welded to the lowerhollow housing portion 205L of the inner housing 204A,204B. Cap assembly215 includes the upper hollow housing portion 205U of the inner housing204A,204B and the hermetically sealed window 206A,206B closing one end.With the cap assembly 215 laser welded to the lower inner housingportion 205L and the ceramic substrate hermetically sealed an end of thelower housing portion 205U, the inner housing 204A,204B is ahermetically sealed unitary piece. The use of a cap assembly 215 may aidin manufacturing, but other methods of assembling the hermeticallysealed inner housing 204A,204B should be evident to those skilled in theart.

In one embodiment, the lower hollow housing portion 205L may be formedof a metal alloy (e.g., steel, iron, nickel, cobalt, and Gadolinium).The lens barrels 235 may be also be formed of a metal or an alloy. Theupper housing portion 205U may be formed of a metal or alloy. The capassembly 215 is inserted over the lens barrels near the lower hollowhousing portion 205L and held in position to make a laser weld along theseam and form a third hermetic seal between the upper housing portionand the lower housing portion.

Dry nitrogen gas may be introduced within the inner housing 204A,204B topreserve the delicate circuitry and optics from oxidation. During thehermetic sealing process of the inner housing 204A,204B, dry nitrogengas may be injected into the inner hollow chamber formed by the innerhousing. Alternatively, the sealing process may be done in a nitrogenrich environment so that nitrogen gas is captured within the innerhollow chamber formed by the inner housing. The process of assembly mayalso be conducted in a “clean room” to further reduce manufacturingdefects.

Referring now to FIG. 2H, a cross section view of a subassembly of theinner housing of the cylindrical shaped camera module is shown withupper polygonal inner portion, lower polygonal inner portion, and capassembly removed. The inner housing 204B further includes a glass window270 having lower edges of a bottom surface resting on a ledge 272 in thelower housing portion 205L. The glass window 270 is sealed on the ledge272 using a glass frit sealant to form a glass frit seal 271, coveringover an opening in the lower housing portion and forming a lower chamberfor the opto-electronics. The window 270 is transparent to wavelengthsof electromagnetic radiation captured by the image sensor. With thelower housing portion 205L supporting the glass window 207, the lowerhousing portion 205L may also be referred to as a frame. As discussedherein, a dry nitrogen gas may be introduced into the lower chamber aswell as an upper chamber sealing off the lens barrels and the optics.The glass window 270 protects the image sensor 320 and the signalconditioning chip 326. The glass window 270 can further provide amounting point for the ends of the lens barrels 235.

The ends of the optical or lens barrels 235 may rest and be attached byglue, UV cured epoxy, or cement to the top surface of the glass window270 in a slight off axis alignment with axes of pixel arrays of theimage sensor 320. The upper housing portion 205U (not shown in FIG. 2H)is welded to a shoulder portion 273 of the lower housing portion 205L.

A recess 274 in the bottom of the lower housing portion 205L forms ashoulder 275. The recess 274 receives a polygonal-shaped seal ring 278in and near sides of the ceramic substrate 208D. The polygonal-shapedseal ring 278 may be formed of KOVAR and brazed onto the ceramicsubstrate 208D, in advance, to match thermal expansion of materials fromheat. The lower housing portion 205L is also formed of KOVAR to matchthe thermal expansion coefficient of the ceramic substrate so that ahermetic seal survives sterilization during an autoclave process. Asolder 279 is soldered into a gap between the shoulder 275 and theceramic substrate 208D to hermetically seal the lower housing portion205L to the ceramic substrate 208D. Portions of the ceramic substrate208D may be metalized so the lower housing portion 205L formed of KOVARmay be attached with a metal to metal seal such as through brazing,soldering, or welding techniques.

The signal conditioning chip 326 is mounted in the cavity 220 with bondwires 224 on left and right sides coupled between bonding pads on thechip and bonding pads 210A-210B. An insulated spacer chip 222 is mountedon top of the signal conditioning chip 326. The stereo image sensor chip320 is mounted on top of the spacer chip 222. Bond wires 225 on one sideare coupled between bonding pads on the chip and bonding pads 210B ofthe ceramic substrate 208D. The ceramic substrate 208D acting as ahermetic barrier, also thermally matches the silicon of the signalconditioning chip 326 and the stereo image sensor chip 320.

An open hollow base cap 290 is coupled to the lower periphery of theceramic substrate 208D to receive a potting material (e.g., siliconepoxy) to protect electronic and opto-electronic components that may bemounted to the bottom surface of the substrate.

Referring now to FIG. 21, a bottom view of the inner housing of thecylindrical shaped camera module is shown. A cylindrical surface mountconnector 230B is mounted to outer pads 210B in the center of the outersurface of the ceramic substrate 208D. The size and central location ofthe connector 230B allow a plurality of chip resistors 297, a pluralityof chip capacitors 298, and a crystal 299 to be mounted to outer pads210B on the outer surface of the ceramic substrate 208D. The crystal 299within an oscillating circuit generates an oscillating signal (e.g., asine wave) that is used to generate a clock signal for the signalconditioning chip and the image sensor (see FIGS. 5A-5B, 6A-6B forexample). The connector 230B includes pins 266 of a proper gender (e.g.,female pins) that mate with pins 268 of the plug 267 with the oppositegender (e.g., male pins). The connector 230B allows four inner signalconnections and one ground/shield outer cylindrical connection so that aquad-axial twisted pair cable can respectively provide power, serialcommunication signal, plus and minus differential video signals, andground.

Referring now to FIGS. 2J, 2K, and 2L, assembled views of the minimallyinvasive surgical camera module 200C are shown. The minimally invasivesurgical camera module 200C includes the outer housing 202 and the innerhousing 204B with the ceramic substrate 208D, the window 270 and thesurface mount connector 230B. To couple the assembled camera module 200Cto the shaft 106 of the endoscopic camera instrument 101, the outerhousing 202 is coupled to the distal end segment 240 of the joint 104(see FIG. 1A).

The minimally invasive surgical camera module 200C further includes acylindrical insert 280 near the distal instead between the walls of theouter housing 202 and the inner housing 204B. The cylindrical insert 280extends down a portion of the height of the camera module. Thecylindrical insert has a center opening to receive the upper hollowcylindrical housing portion and a plurality of radial spaced openings281A-281B,282A-282B (see FIG. 2L) to receive groups or bundles ofoptical fibers 312 to form concentrated light areas. Optical fibers 312routed through the instrument shaft are guided into the camera module byfiber sheaths 258. The optical fibers 312 are grouped together intogroups and routed between the walls of the housings 202,204B and intothe plurality of openings 281A-281B,282A-282B of the cylindrical insert280.

The cylindrical insert 280 is formed out of an insulator or dielectricmaterial (e.g., a high performance plastic such as ULTEM) to helpelectrically isolate the inner housing from the outer housing. Further,the cylindrical insert maintains alignment of the distal ends of theinner housing and the outer housing. Epoxy is inserted to backfill fromthe end of the cylindrical insert any remaining air space between theinner housing 204B and the outer housing 202.

FIG. 2L is a top view of the assembled cylindrical shaped camera module200C. FIG. 2L shows an exemplary distribution of the optical fibers 312into the openings 281A-281B,282A-282B of the cylindrical insert 280. Asopenings 281A-281B are closer to the center axis 229 of the cameramodule than the openings 282A-282B, a greater number of optical fibersare grouped into the side openings 282A-282B that the number of opticalfibers grouped into the top and bottom openings 281A-281B to provide amore even overall light distribution about the distal end of the cameramodule.

Excess length of the optical fibers 312 extending beyond the front edgeof the outer housing 202 may be removed by grinding and polishing. Thedistal ends of optical fibers 312 are ground and polished flush with theedge of the outer housing 202, leaving a smooth polished edge betweenthe outer housing 202 and the sapphire window 206A,206B. A polished edgeof the optical fibers 312 can emit more light and can be easier toclean, disinfect, and sterilize.

FIG. 3A is a diagrammatic view of a camera module 300 coupled to theinstrument shaft 106 at a weld point 316. The camera module 300 is aninstance of the camera module 100 previously described in the endoscopiccamera system 100 of FIG. 1A.

The camera module 300 generally employs the housing structure200A,200B,200C described previously with reference to FIGS. 2A-2L Ahollow stainless steel, titanium, aluminum, or metallic alloy (e.g.,KOVAR) cylinder may form the outer housing 202 of the camera module 300.A hollow metal or metallic alloy (e.g., KOVAR, a nickel-cobalt ferrousalloy) cylinder may form the inner housing 204A,204B. To couple theassembled camera module 300 to the shaft 106 of the endoscopic camerainstrument 101, the outer housing 202 may be laser welded to the distalend (segment 240) of the joint 104 (joggle joint and wristed joint asmentioned herein).

Nestled between the walls of the outer housing 202 and the inner housing204A,204B are the optical fibers (may also referred to as light guidefibers) 312. The optical fibers 312 may be evenly distributed tosurround the inner housing 204A. To evenly distribute the light in ahalo shape around the inner housing 204A, multiple individually finestrands of optical fiber may be bound together with epoxy and pre-formedinto a tubular shell for insertion between the outer housing 202 and theinner housing 204A. Alternatively, the optical fibers 312 may be lumpedtogether in areas about the inner housing 204B with a dielectric epoxy250B filling the gaps between the inner housing 204B and the outerhousing 202 as shown in FIG. 2B. Excess length of the optical fibers 312extending beyond the front edge of the outer housing 202 may be removedby a grinding and polishing process. The distal ends of optical fibers312 are ground and polished flush with the edge of the outer housing202, leaving a smooth polished edge 313 between the outer housing 202and the sapphire window 206A,206B. A polished edge 313 of the opticalfibers 312 may emit more light and may be easier to clean, disinfect,and sterilize.

The distribution of the optical fibers 312 surrounding the inner housing204A,204B and a dielectric epoxy 250B may also serve to electricallyisolate the inner housing (and the components therein). The innerhousing 204A,204B of the camera module may be grounded to reduce noise.One or more of the cylindrical insert 280, the optical fiber 312, andthe dielectric epoxy 250B can provide a high voltage dielectric barrierto help isolate the grounded portions of inner housing 204A,204B fromthe outer housing 202 and isolate a patient from ground to help meetcardiac float (CF) and/or body float (BF) safety and electro-magneticcompliance for medical systems in physical contact with a patient (e.g.,see IEC specification IEC60601). Portions of the inner housing 204A,204Bmay be further isolated from making patient contact so that materialsthat may be less biocompatible can be used in the design of the innerhousing.

In one embodiment, the sapphire window 206A,206B may be coupled to theinner side of inner housing 204A,204B flush with the distal edge ofinner housing and the polished edge of optical fibers 312. Tohermetically seal the sapphire window 206A,206B to inner housing204A,204B forming the hermetic seal 314A, 314B, a gold solder may beused as the sealant. To solder sapphire window 206A,206B onto a metallicsurface, the edge of sapphire window to couple to the housing may bemetalized to aid adhesion of the gold solder. At the proximal end ofinner housing 204A,204B, the ceramic substrate 208, 208′,208A,208B isattached to the inner housing by a laser welding process. The crosssection of weld joint forming the hermetic seal 318,318′ is shown inFIGS. 3A-3B as being a hollow oval shape. However, the weld joint may beflat and in the shape of a band around the periphery of the ceramicsubstrate 208,208′. With both ends of inner housing 204A,204Bhermetically sealed, the optics and electro-optics of the camera module300 may be protected during an autoclave cycle of the instrument 101.

Behind sapphire window 206A,206B is a pair of lens barrels 302 that arean example of the lens barrels 235 shown in FIGS. 2F and 2G. Each lensbarrel 302 may include a hollow tube 321, a plurality of lenses 322, anda plurality of hollow spacers 323 interspersed between a lower innerstop ring and a top edge of the hollow tube. Each lens barrel 302 mayhold the plurality of lenses 322 along optical axes substantiallyperpendicular with the image sensor 320. Light passing through sapphirewindow 206A,206B is focused by lenses 322 onto active pixel areas of theimage sensor 320A,320B. The image sensor 320A,320B is a stereo analog ordigital image sensor with active pixel areas that may be a CCD, a CMOScamera sensor, an intensified charge-coupled device (ICCD), etc. tocapture stereo color or stereo monochrome images of the surgical site.With an analog image sensor, an analog to digital converter may be usedto convert the analog image signals into digital image signals toprovide noise immunity. The sensor 320A,320B may capture visibleelectromagnetic (EM) radiation within the visible EM spectrum as well asother ranges of EM radiation outside the visible EM spectrum.

Instruments, such as an endoscopic camera, used in endoscopy are smallto fit into entry port incisions or natural entry points of a patient.To accelerate post surgery recovery, endoscopy reduces tissue damage.Thus, in general, the smaller the tool, the better. Thus, it isdesirable to reduce the size of the image sensor to provide a smallerendoscopic camera module. To provide better image resolution, however,it is desirable to provide more active pixels in the image sensor.

In one embodiment, the number of active pixels on the front of the imagesensor may be maximized by separating the capturing function of thephotoactive region of the image sensor from the processing function.(e.g., see FIGS. 6A-6B) By separating the two functions, a greateramount of die area may be used for a photoactive region of the imagesensor relative to the die's overall area. This relatively largerphotoactive region allows for a larger number of pixels to be formed,which enables higher definition stereo images to be captured.Alternatively, the die area of the image sensor may be reduced toprovide a smaller cross section of the endoscope without sacrificingimage resolution provided by an image sensor having a relatively largerdie area. As discussed further herein, the image capturing function maybe separated from the signal processing function into two chips to meetspace requirements. The integrated circuit chips may be shielded and/orspaced apart from one another to provide better signal quality as well(e.g., see FIGS. 5A, 5B, 6A, and 6B, and their associated text.)

Image sensor 320A having ball grid array contacts is mounted onto innerpads 210 of the ceramic substrate 208A. The solder balls 310A arecoupled to the inner bond pads 210 on the inner surface of ceramicsubstrate 208A and a surface of the image sensor 320A. The solder balls310B of the signal condition processor 326A are coupled to second bondpads 210 on the outer surface of ceramic substrate 208A and a surface ofthe processor 326A. Traces within the substrate 208A connect inner bondpads 210 to outer bond pads 210 so that the image sensor 320A can coupleto circuitry and electrical cables outside the hermetic seal 318.Conductive layers, metallic traces, redistribution layers (vias), and/orwire leads may be embedded or printed on the inner layers of ceramicsubstrate 208A to connect the first set of bond pads on the innersurface to the second set of bond pads on the outer surface of ceramicsubstrate 208A (e.g., see FIGS. 5A-5B and description thereof).

Using a multilayer co-fired ceramic substrate allows connection throughthe substrate without the use of via tubes. Via tubes are glass orplastic tubes embedded in the ceramic substrate, through which wires maybe threaded to connect circuitry on opposite sides of a substrate. Theuse of via tubes is labor intensive, because each tube connection isnormally made by hand. Furthermore, via tubes may have gaps between wireand tube that may require sealant or potting material. Thus, the use ofa multilayer ceramic substrate may be preferable for a camera modulethat will undergo autoclaving.

Connection between the hermetically sealed image sensor 320A and theprocessor 326A may be made by the traces within the substrate 208A. Bondpads 210B of the substrate 208A may also be use to electrically connectto the signal cable 328A to transmit video data out to CCU 112.

Processor 326A mounted to the outer surface of ceramic substrate 208Aprocesses analog image data Ain from image sensor 320A and generatesdigital image data output Dout. Power, digital ground, and analog groundsignals for the image sensor 320A, processor 326A, and other componentsin the camera module 300 may be provided for by electrical conductors incable 330. The cable 330 may also have one or more control signalconductors or wires to control the camera module to start and stop videocapture, for example.

In FIG. 3B, a schematic diagram of a cylindrical camera module 300B isshown. The similarly numbered components shown in FIG. 3B in comparisonwith FIG. 3A were previously described and are incorporated herein byreference so that they are not being described again for the sake ofbrevity.

In the cylindrical camera module 300B, the distal edge of inner housing204′ is slightly shorter than distal edge of the outer housing 202. Thisgap allows the sapphire window 206′ to be soldered to the leading edgeof inner housing 204′ so that the outer surface of the window is flushwith the edge of the outer housing 202 as shown. In the previouslydescribed embodiment in shown in FIG. 3A, the sapphire window 206A,206Bwas soldered to the inner edge of inner housing 204A. Gold solder isused to solder the sapphire window 206′ flush with the outer housing 202and to form the hermetic seal 314′ between the inner surface of thewindow 206′ and the edge of the inner housing 204′. In either case, thefront of camera module 300B presents a smooth surface to reduce thenumber of crevices and aid cleaning.

In another embodiment, a vertical cavity surface emitting laser (VCSEL)324 may be used for optical fiber data transmission as shown in FIG. 3B.VCSELs are capable of delivering over one gigabit per second (Gbit/s) ofdata transmission over optical fibers at temperatures of up to 60° C. Asmentioned before, a surgeon's ability to perform precise, meticulousendoscopic surgery is enhanced by the surgeon's ability to view thesurgical field in detail. High definition cameras may be used to deliversharp contrasted images that a surgeon can see during surgery. The VCSEL324 may be able to transmit the high definition images over the opticalfiber 328B to the camera control unit and/or the surgeon's monitor.Another advantage of using fiber optic data transmission is theelimination of cross talk or signal interference from other electronicsignals (e.g., control signals) and its immunity to electrocauteryinterference.

Processor 326A and VCSEL 324 may be encapsulated by a sealant ortemperature/moisture resistant potting material 332. The processor 326Aand VCSEL 324 are candidates for encapsulation because they do not needto directly receive light images focused by lens 322. By separating thefunctions of image sensor 320A, processor 326A and VCSEL 324 intodifferent chips, the image sensor 320A may be hermetically sealed withother optical components behind sapphire window 206. Light may passthough sapphire window 206 to impact upon the image sensor 320A, whilethe processor 326A and VCSEL 324 may be placed behind the ceramicsubstrate 208A and encapsulated by sealant or potting material 332.Placement of processor 326A and VCSEL 324 outside the inner may aidreplacement of either component in case of failure.

Another embodiment may use utilize a combination fiber optic/copperco-axial cable connected to a short length of ribbon cable to transmitdata to CCU 112. Briefly referring back to FIG. 2B, a co-axial cable 236is connected to a ribbon cable 238 and threaded through the end segment240 of the joint 140. The plurality of cables 242 may be shielded from“noise” and cross-talk by individually sheathing each cable in anon-conductive covering. Similarly sheathing 244 and 246 may furtherisolate the cables from outside noise as well as physical damage. Thesegment 240 of the joint 140 may be connected to the proximal end ofcamera module 102. Specifically, the segment 240 may be welded to cameramodule 102 at the weld point 316 shown in FIGS. 3A-3B. The joint 140 maybe a wristed joint or a potion of a joggle joint that is described inU.S. patent application Ser. No. 11/762,165, entitled MINIMALLY INVASIVESURGICAL SYSTEM, filed by Larkin et al. on Jun. 13, 2007. The use of apluggable cable 238 may be advantageous in the assembly process. Asmentioned previously, connector 230 may be surface mounted to the backside of substrate 208 for quick disconnect of cable 238 and replacementof camera module 102.

Isolation and Grounding

Referring now to FIGS. 5A and 6A-6B, aspects of the camera module areillustrated in further detail. In response to control signals C, theimage sensor 320A has at least one pixel array (e.g., see left and rightpixel arrays 600L,600R shown in FIG. 6A) that captures analog signalsAout. The signal conditioning processor 326A,326B includes an analog todigital (A/D) converter 627 and a controller 626. A substantial portionof the digital signal processing and the analog to digital conversion isperformed by the processor 326A,326B. With signal conditioning functionsmoved to the processor 326A.326B, one or more pixel arrays may be madelarger to support capturing stereo high definition images on a singlechip. With the processor 326A,326B and the image sensor 320A,320Bprovided on separate chips, they may make separate connections to powerand ground terminals of a power supply with separate wire bonds forexample.

Although isolating the image sensor 320A from the processor 326A byplacing them on opposite sides of ceramic substrate 208A may have someadvantages, it is also feasible to stack the chips one above the other.The image sensor 320A may be stacked above the processor 326A, inparallel or perpendicular to each other, and both chips may be placedwithin the cutout recess 220. In such an arrangement, the chips320A,326A are protected within the hermetic seal of the inner housing204 and may be wire bonded to the ceramic substrate. Alternatively,through-hole silicon via technology may be used to have the chips320A-326A connect to each other and the ceramic substrate.

The ceramic substrate 208A may include pads 510A on one side to coupleto the image sensor 320A and pads 510B on an opposite side to couple theprocessor 326A. The image sensor 320A includes corresponding pads 510Acoupled to the solder balls 310A that are coupled to the pads 510A ofthe substrate 208A. The processor 326A includes corresponding pads 510Bcoupled to the solder balls 310B that are coupled to the pads 510B ofthe substrate 208A. The analog to digital converter 627 is coupled toone or more pads 510B to receive analog input signals Ain. The signalprocessor 626 is coupled to one or more pads 510B to drive controlsignals C and digital data signals Dout as well as receive controlsignals. The digital data signals D represent portions of one or morecaptured stereo images captured by the image sensor. The digital datasignals D are sent from the camera module and the instrument 101 to thecamera control unit CCU 112 (see FIG. 1A) for further processing (e.g.,decoding/translating, error detection/correction, image shifting) ofstereo image data before being displayed by the stereo viewer 118A,118B.The digital data signals D are sent as differential digital data signalsover a pair of conductors to provide a more robust noise immune signalinto the camera control unit 112.

For power, ground, and signals (A,C) to route from one side of theceramic substrate 208A to the other, the ceramic substrate includes aplurality of metal layers 508A-508C with metal traces coupled betweenpads 510A-510B to seal moisture out. Exemplary substrates with layers ofmetal traces are described in further detail in U.S. Pat. Nos. 5,635,301(Kondo et al.); 6,228,468 (Vodrahalli); and 6,891,266 (Kinayman et al.),all of which are incorporated herein by reference. The moisture proofseal provided by the ceramic substrate 208A is important to keepmoisture from the image sensor 320 and the lenses 322 in the lens arrays302 of the camera.

The endoscopic camera may be part of an entry guide that comes incontact with a patient. In which case, it is desirable to allow theouter housing 202 of the camera module and the shaft of the endoscopiccamera to electrically float so that it does not inadvertently providean electrical path to ground. However to improve signal to noise ratiosfor the signals transmitted from the camera module, the inner housing204A,204B of the camera module may be grounded if barriers are used toavoid the inner housing from making contact with the patient.Additionally, signals may be transmitted as a differential signal withan error correction code (ECC) and/or shielded within a shielded cableto improve signal to noise ratios.

The inner housing 204A,204B is formed of an electrically conductivematerial to ground it out to reduce electrical noise and improve signaltransmission from the camera module. With the inner housing 204A,204Bgrounded, electrical noise around the image sensor 320A,320B may befurther reduced so that less noise may be coupled into signals. With theinner housing 204A,204B grounded, the inner housing is electricallyisolated from the outer housing 202 that is to electrically float.

The optical fiber 312 arrayed around the inner housing 204A,204B betweenthe inner and outer housings may electrically isolate a grounded innerhousing from a floating outer housing 202. A non-conductive adhesive(e.g., dielectric epoxy 250B shown in FIG. 2B) may be applied to thearray of optical fiber 312 to fill in gaps between strands of opticalfibers and the inner and outer housings for further electricalisolation.

As shown in FIG. 3B, an end of the inner housing 204′ does not extend asfar out as the end of the outer housing 202. The window 206′ is coupledon top of the end of the inner housing 204 with a hermetic seal 314′ asshown to prevent moisture from entering the inner cylindricalsubassembly. The window 206′ being formed of a non-conductive material,such as sapphire, is an insulator and electrically isolates the groundedinner housing 204 from tissue in a body cavity during surgery. Anon-conductive potting material 332 may also cover over the opposite endof the inner housing 204′, the substrate 208A, the processor 326A andthe VCSEL 324 to further electrically isolate the grounded inner housing204 from the floating outer housing 202. The potting material 332 alsokeeps moisture from the processor 326A, the VCSEL 324 and any otherelectrical component at the end. In this manner, the cylindrical innerhousing 204′ is substantially electrically isolated from the outerhousing 202 and any tissue that the camera module may come in contactwith. Alternatively, the cylindrical inner housing 204′ may also beallowed to electrically float and the signals may be transmitted as adifferential signal with an error correction code (ECC) and/or shieldedwithin a shielded cable.

Area Conservation

Referring now to FIG. 5B, alternate aspects of the camera module areillustrated. In this case, the image sensor 320B mounts to the processor326B in a stacked configuration within the inner can 204A,204B toprovide a large image sensor while conserving the cross sectional areaof the endoscope. The pad 510C on each are coupled together by thesolder balls 310C. The processor 326B in turn mounts to the substrate208B to electrically couple to the pins 526 through the solder balls310A and the pads 510A. Alternatively, the pads 510A of the processor326B may be wired bonded to the pads 510A of the substrate 208B.

Power, ground, and control signals from the pins 526 may be coupled intothe processor 326 through the substrate 208B by way of the pads 510A andthe solder balls 310A. Power, ground, and control signals may couplefrom the pins 526 to the image sensor 320B through the processor 326B.One or more vias 529 may couple a pad 510A on one side of the processor326B to a pad 510C on the opposite side to route power, ground, and/orcontrol signals from one side of the chip to the other. Alternatively, atrace may route around the edge of the chip from one side to the other.Analog signals Aout from the image sensor 320B may couple into theanalog input Ain of processor 326B through the pads 510C and solderballs 310C.

Male pins 526 may couple to female pins 566 in a connector 560 which arecoupled to the cable routed through the shaft of the endoscope for thecamera module to receive power, ground, and control signals and transmitdata to the camera control unit.

One or both of the image sensor 320B and the processor 326B may includea ground plane 521A,521B to shield the analog circuits of the sensor320B from digital noise that may be generated by the processor 326B.

Stereo Image Convergence

Referring now to FIGS. 6A and 7, a stereoscopic endoscope requires imageconvergence to provide proper stereo images and depth perception to apair of human eyes with pupil separation. One way of providing imageconvergence is to slightly angle each of the left and right lenses intoleft and right image sensors. Another method of providing imageconvergence is to offset the center of left and right image sensors fromrespective left and right optical axes of the left and right lens arrayswithout any change in optical axes. The centers of left and rightcaptured images may also be similarly offset to the centers of left andright displays by image shifting for image convergence when displayed bya stereo viewer to improve stereo imaging effects.

FIG. 6A illustrates a stereoscopic image sensor 320A,320B with a leftpixel array 600L and a right pixel array 600R separated by analogprocessing circuitry 602. The left pixel array 600L, the right pixelarray 600R, and the analog processing circuitry 602 are on the samemonolithic silicon die, avoiding having to align the left and rightpixel arrays relative to each other. The left pixel array 600L has aleft pixel center 601L and the right pixel array 600R has a right pixelcenter 601R. Each of the pixel arrays 601L,601R may be an array of 1280pixels wide by 1080 pixels high, for example, to provide a relativelyhigh definition stereo image. The left pixel center 601L and the rightpixel center 601R are separated by a sensor separation distance Dssep610.

The left pixel array 600L and the right pixel array 600R arehorizontally read out along rows of pixels in each by the analogprocessing circuitry 602. The analog processing circuitry 602 to readeach array is co-located between the arrays 600L and 600R to reducecircuit area and overall die size of the image sensor.

FIG. 7 illustrates how the center of the left and right image sensorsare offset from the respective left and right optical axes of the leftand right lens arrays for stereo image convergence. The center axis ofeach lens in the left lens array 322L is aligned to a left optical axis702L. The center axis of each lens in the right lens array 322R isaligned to a right optical axis 702R. A left pixel center axis 701Lextends through the left pixel center 601L substantially perpendicularto a layer of the left pixel array 601L. A right pixel center axis 701Rextends through the right pixel center 601R substantially perpendicularto a layer of the right pixel array 601R. The left pixel center axis701L, the right pixel center axis 701R, the left optical axis 702L andthe right optical axis 702R are substantially parallel to each other.Each may also be substantially parallel to a center axis 702C. Howeverfor image convergence, the left pixel center axis 701L is not coaxialwith the left optical axis 702L. Nor is the right optical axis 702Rcoaxial with the right pixel center axis 701R,

It is desirable to have stereo image convergence at a point 700 alongthe center axis 702C that is a distance Dconv 712 away from a plane(e.g., a surface of the sensor 320A,320B) passing through the left pixelcenter 601L and the right pixel center 601R. To provide the stereo imageconvergence, the left pixel center 601L of the left pixel array 600L isshifted out from the left optical axis 702L of the left lens array 322Lby a left pixel array offset 704R. The right pixel center 601R of theright pixel array 600R is shifted out from the right optical axis 702Rof the right lens array 322R by a right pixel array offset 704R. In thismanner, the sensor separation distance Dssep 610 is greater than anoptical separation distance Dosep 710 between the left optical axis 702Land the right optical axis 702R.

Rectangular Endoscopic Camera Module

The housing of the camera module may have other shapes and may have apluggable connector to plug into a receptacle in the shaft of endoscopiccamera. For example, the housing of the camera module may be circular orrectangular. The pluggable camera module at the tip of endoscope may bea single use disposable camera tip module that is discarded after eachsurgery. In which case, the disposable pluggable camera module does notrequire sterilization by autoclaving after surgery. Instead of beingdesigned to survive autoclaving, the disposable pluggable camera moduleis designed for low cost.

Referring now to FIG. 4A, a rectangular camera module 400 is illustratedin another embodiment. The rectangular camera module 400 includes anouter rectangular housing 402, an inner rectangular housing 404, awindow 406, and an array of optical fibers 412. The outer rectangularhousing 402 and a portion of the inner rectangular housing 404 arepreferably formed out of other moisture proof materials such asstainless steel or KOVAR.

FIG. 4B illustrates an exploded view of an inner subassembly with theinner housing 404 decoupled from a ceramic substrate (base) 408. Asshown in FIG. 4B, the inner rectangular stainless steel housing 404 isenclosed on five sides like a rectangular box but with an open bottomthat is closed by the substrate 408. The substrate 408 may include ahousing mounting pad 434 to receive the inner housing 404 and seal theoptic, optical electrical, and electrical elements therein. The window406 is set into an opening at the distal end of the inner rectangularstainless steel housing 404. The window 406 is hermetically sealedwithin an opening at a front end of the inner housing 404.

The window 406 may be made of any suitably scratch, heat, moisture, andsolvent resistant material that is also transparent to a range ofwavelengths detected by the image sensor 420 behind the window. In oneembodiment the window is a sapphire window 406 brazed onto the innerhousing 404. To braze a sapphire window 406 onto a metallic surface, theperipheral edge of sapphire window 206 may be metalized to aid adhesion.In other embodiments, the sapphire window 406 may be soldered onto innerhousing 404 using a gold solder.

The inner rectangular stainless steel housing 404 is hermetically sealedto the ceramic substrate 408 through welding or other techniques to forma base and close the open side of the inner housing 404. Optical fibers412 surround the first housing 404. The outer steel housing 402 is openat a front end and a back end. The outer housing 402 slides over theoptical fibers 412 around the first housing 404.

In between the inner housing 404 and the outer housing 402 are arrangedthe plurality of optical fibers 412. The optical fibers 412 may occupythe entire space between inner housing 404 and outer housing 402 suchthat light launched out from optical fiber 412 may form a halo aroundthe front of inner housing 404. An adhesive may be used to fill in gapsbetween the fibers 412 as well as between the inner housing and outerhousing. Alternatively, an end portion of the optical fibers 412 may bemolded together to fit within the gap between the inner housing andouter housing with an adhesive filling any gaps. In another embodiment,the optical fiber 412 may be bundled and routed to discrete point orpoints on the front of camera module 400, providing a more localizedlight source.

In FIG. 4B, a subassembly of the rectangular endoscope camera module 400is exposed with the inner housing 404 lifted up and the fibers 412 andouter housing 402 not shown. The inner housing 404 is lifted off ofceramic substrate 408 to expose the electrical, optical, andelectro-optical components inside the camera module. As previouslymentioned, it may be beneficial to substantially match the thermalexpansion of the inner housing 404 to that of the ceramic substrate 408.Forming the inner housing 204 out of a substance such as nickel-cobaltferrous alloy may reduce stress on the ceramic substrate due to thermalexpansion during an autoclave cycle.

Mounted over ceramic substrate 408 are a pair of objective lenses 422(one each for left and right images of a stereo image), a mirrored prism424, and an image sensor 420. The objective lenses 422 are secured suchthat light passing through the sapphire window 406 along their opticalaxes is focused into the mirrored prism 424. The mirrored prism 424redirects the light at a right angle to its original path along theoptical axes onto the image sensor 420 that is mounted to the substrate408.

As with previously described embodiments, image sensor 420 may be acharged-couple device (CCD), a CMOS sensor, an intensifiedcharge-coupled device (ICCD), etc. To maximize the number of activepixels on the front of the image sensor 420, the analog to digitalconverters 627, digital signal processing components 626, and otherdigital circuits may be separated from the photoactive region of theimage sensor 420 and merged together into a processor 426A that ismounted to the substrate 408. Passive components 426P may be mounted tothe substrate 408. By separating the image sensor circuit from theprocessor and passive components, the area of the image sensor undermirrored prism 424 may be devoted to increased pixel density and higherresolution.

Wire bonds 428 electrically couple the image sensor 420 to traces in thesubstrate 408 to couple the processor 426A and the passive components426B to each other and to cable bond pads 410. The traces (e.g., seemetal layer 508A-508C in FIG. 5) pass under the hermetic seal by way ofthe ceramic substrate 408 to couple to the cable bond pads 410 outsidethe hermetically sealed inner housing 404. The cable bond pads 410 maybe connected to one or more sheathed cables to receive control signalsand power and transmit data along the shaft of the endoscope. Thesheathed cables may travel down the length of the surgical instrumentand connect the camera module 400 to a surgeon's display console.Alternatively a VCSEL outside the hermetic seal may be mounted to thesubstrate 408 to transmit data via optical fiber instead of anelectrical cable.

Conclusion

While this specification includes many specifics, these should not beconstrued as limitations on the scope of the disclosure or of what maybe claimed, but rather as descriptions of features specific toparticular implementations of the disclosure. Certain features that aredescribed in this specification in the context of separateimplementations may also be implemented in combination in a singleimplementation. Conversely, various features that are described in thecontext of a single implementation may also be implemented in multipleimplementations, separately or in sub-combination. Moreover, althoughfeatures may be described above as acting in certain combinations andeven initially claimed as such, one or more features from a claimedcombination may in some cases be excised from the combination, and theclaimed combination may be directed to a sub-combination or variationsof a sub-combination. Accordingly, the claimed embodiments are limitedonly by patented claims that follow below.

What is claimed is:
 1. A minimally invasive surgical system comprising:a patient side manipulator having at least one robotic arm; ahermetically sealed endoscopic camera instrument having a housing at aproximal end removably coupled to the at least one robotic arm of thepatient side manipulator, the camera instrument further having ahermetically sealed camera sensor at a distal end to capture images of asurgical site, a shaft coupled to the housing, and one or more wristedjoints coupled to and between the shaft and the hermetically sealedcamera sensor; a vision cart having a camera control unit, wherein thecamera control unit is coupled in communication with the hermeticallysealed camera sensor at the distal end of the camera instrument tocapture the images of the surgical site; and a monitor coupled incommunication with the camera control unit to display the capturedimages of the surgical site.
 2. The minimally invasive surgical systemof claim 1, wherein the camera sensor is a stereo camera sensor tocapture stereo images; and the monitor is a stereo viewer to display thecaptured stereo images of the surgical site.
 3. The minimally invasivesurgical system of claim 1, wherein the hermetically sealed endoscopiccamera instrument further has a plurality of optical fibers routed fromthe housing, through the shaft, and the wrist and around thehermetically sealed camera sensor to the distal end to provide light inthe surgical site; and internal sheathed electrical cables routed fromthe housing, through the shaft, and the wrist to the hermetically sealedcamera sensor.
 4. The minimally invasive surgical system of claim 3,wherein the vision cart further has an illuminator coupled incommunication with the plurality of optical fibers to provide the lightin the surgical site at the distal end of the hermetically sealedendoscopic camera instrument.
 5. The minimally invasive surgical systemof claim 4, further comprising a light guide coupled between theilluminator and the housing of the hermetically sealed endoscopic camerainstrument, wherein the light guide couples the illuminator incommunication with one or more of the plurality of optical fibers routedto the distal end to provide light in the surgical site.
 6. Theminimally invasive surgical system of claim 1, further comprising:external sheathed electrical cables coupled between the camera controlunit and the housing of the hermetically sealed endoscopic camerainstrument, wherein one or more of the external sheathed electricalcables couples the camera control unit in communication with one or moreof the internal sheathed electrical cables and the hermetically sealedcamera sensor at the distal end to capture images of the surgical site.7. The minimally invasive surgical system of claim 5, furthercomprising: external sheathed electrical cables coupled between thecamera control unit and the housing of the hermetically sealedendoscopic camera instrument, wherein one or more of the externalsheathed electrical cables couples the camera control unit incommunication with one or more of the internal sheathed electricalcables and the hermetically sealed camera sensor at the distal end tocapture images of the surgical site.
 8. The minimally invasive surgicalsystem of claim 7, wherein the external sheathed electrical cablescoupled between the camera control unit and the housing of thehermetically sealed endoscopic camera instrument are quick disconnectsheathed electrical cables with one or more connectors to facilitatequick disconnect for sterilization.
 9. The minimally invasive surgicalsystem of claim 8, wherein the light guide coupled between theilluminator and the housing of the hermetically sealed endoscopic camerainstrument is a quick disconnect light guide with one or more connectorsto facilitate quick disconnect for sterilization.
 10. The minimallyinvasive surgical system of claim 1, further comprising: a mastercontrol console coupled in communication with the camera control unit,the at least one robotic arm of the patient side manipulator, and thehermetically sealed endoscopic camera instrument, the master controlconsole to control the camera control unit and the hermetically sealedendoscopic camera instrument in the capture of images of the surgicalsite.
 11. The minimally invasive surgical system of claim 10, whereinthe master control console to further control the at least one roboticarm of the patient side manipulator in the capture of images of thesurgical site.
 12. The minimally invasive surgical system of claim 10,wherein the camera sensor is a stereo camera sensor to capture stereoimages; the master control console includes the monitor coupled incommunication with the camera control unit to display the capturedimages of the surgical site; and. the monitor is a stereo viewer todisplay captured stereo images of the surgical site.
 13. A minimallyinvasive surgical system comprising: a hermetically sealed endoscopiccamera instrument having a housing at a proximal end removably coupledto a robotic arm of a patient side manipulator, the camera instrumentfurther having a hermetically sealed camera sensor at a distal end tocapture images of a surgical site, a shaft coupled to the housing, andone or more wristed joints coupled to and between the shaft and thehermetically sealed camera sensor; a camera control unit coupled incommunication with the hermetically sealed camera sensor at the distalend of the camera instrument to capture the images of the surgical site;and a monitor coupled in communication with the camera control unit todisplay the captured images of the surgical site.
 14. The minimallyinvasive surgical system of claim 13, wherein the camera sensor is astereo camera sensor to capture stereo images; and the monitor is astereo viewer to display the captured stereo images of the surgicalsite.
 15. The minimally invasive surgical system of claim 13, whereinthe hermetically sealed endoscopic camera instrument further has aplurality of optical fibers routed from the housing, through the shaft,and the wrist and around the hermetically sealed camera sensor to thedistal end to provide light in the surgical site; and internal sheathedelectrical cables routed from the housing, through the shaft, and thewrist to the hermetically sealed camera sensor.
 16. The minimallyinvasive surgical system of claim 15, further comprising: an illuminatorcoupled in communication with the plurality of optical fibers to providethe light in the surgical site at the distal end of the hermeticallysealed endoscopic camera instrument.
 17. The minimally invasive surgicalsystem of claim 16, further comprising a light guide coupled between theilluminator and the housing of the hermetically sealed endoscopic camerainstrument, wherein the light guide couples the illuminator incommunication with one or more of the plurality of optical fibers routedto the distal end to provide light in the surgical site.
 18. Theminimally invasive surgical system of claim 13, further comprising:external sheathed electrical cables coupled between the camera controlunit and the housing of the hermetically sealed endoscopic camerainstrument, wherein one or more of the external sheathed electricalcables couples the camera control unit in communication with one or moreof the internal sheathed electrical cables and the hermetically sealedcamera sensor at the distal end to capture images of the surgical site.19. The minimally invasive surgical system of claim 17, furthercomprising: external sheathed electrical cables coupled between thecamera control unit and the housing of the hermetically sealedendoscopic camera instrument, wherein one or more of the externalsheathed electrical cables couples the camera control unit incommunication with one or more of the internal sheathed electricalcables and the hermetically sealed camera sensor at the distal end tocapture images of the surgical site.
 20. The minimally invasive surgicalsystem of claim 7, wherein the external sheathed electrical cablescoupled between the camera control unit and the housing of thehermetically sealed endoscopic camera instrument are quick disconnectsheathed electrical cables with one or more connectors to facilitatequick disconnect for sterilization; and the light guide coupled betweenthe illuminator and the housing of the hermetically sealed endoscopiccamera instrument is a quick disconnect light guide with one or moreconnectors to facilitate quick disconnect for sterilization.